Routine cancer screening is an accepted part of ongoing health maintenance — but when a patient already has advanced cancer and life expectancy is limited, screening for other cancers makes less sense. Although that may be a tough bit of information for a doctor to impart, the truth is it may be what’s better for the patient.

Screening patients with terminal cancer for other forms of the disease has probably been “a matter of habit,” explained Deborah Schrag, MD, MPH, one of the authors of the study “Cancer Screening Among Patients with Advanced Cancer” published in a recent issue of the Journal of the American Medical Association.

According to the study, patients with advanced throat cancer were regularly screened for breast, cervix, prostate and colon cancers. The researchers looked at more than 87,000 Medicare patients with advanced cancer who were tested for these four types of the disease, comparing them with a similar number of Medicare enrollees (matched for race, age and gender) who did not have cancer. The study concluded that some patients with advanced-stage cancer continue to get screened even when these tests have no “meaningful likelihood” of extending life.

A Sad Conclusion

This is a sensitive issue, of course, which is why I contacted Dr. Schrag to ask for her insights. After all, even if a person doesn’t have long to live, doesn’t it make sense to know about the types of cancer that haven’t yet caused symptoms?

Dr. Schrag said the problem is that these tests themselves come with certain dangers. She pointed out that finding a new malignancy will “virtually always lead to overdiagnosis,” which is defined as detection of a cancer which, if not found by active search, would not affect survival. She added that “other problems arise due to subsequent testing, biopsies and psychological distress.” Though cost is not a primary concern, the tests also are wasteful “because they don’t benefit patients,” she said. Screening itself isn’t all that expensive — usually less than a few hundred dollars for the tests in the study — but follow-up procedures can be costly if evidence of cancer is found.

Whether or not to continue to get screening tests for cancer is obviously a very personal decision that patients should make in consultation with their physicians. Considerations include whether or not detecting a new cancer and treating it has the potential to extend the patient’s life. Of course, these decisions need to be made within the context of individual circumstances. But for most patients with advanced cancers, such interventions haven’t been shown to provide benefit.